[Acquired hemophilia complicated with multiple muscle abscess by Nocardia]

Rinsho Ketsueki. 2009 Jun;50(6):495-8.
[Article in Japanese]

Abstract

An 82-year-old man was referred to our hospital because of bilateral leg swelling and ecchymosis. A hemostatic study showed prolonged aPTT, <1% factor VIII coagulant activity, and a high titer (30.4 Bethesda Units/ml) of factor VIII inhibitor. The diagnosis of acquired hemophilia A (AHA) was made, and treatment with prednisolone (PSL) was started. Within one month of treatment, the hemorrhagic symptom disappeared, aPTT levels returned to normal, and his factor VIII inhibitor was eradicated; however, factor VIII inhibitor was detected again when PSL was decreased to 10 mg/day. We then added cyclosporine A (CyA) to PSL as a second line salvage therapy. CyA therapy resulted in the resolution of AHA with marked and prolonged efficacy; however, hot, red tumors appeared in his right arm and left thigh. Needle aspiration of the tumors revealed muscle abscess, and Nocardia brasiliensis was isolated. We started treatment with sulfamethoxazole-trimethoprim, and the abscess healed promptly without recurrence.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Abscess / complications*
  • Abscess / therapy
  • Aged, 80 and over
  • Biopsy, Fine-Needle
  • Cyclosporine / adverse effects
  • Cyclosporine / therapeutic use
  • Hemophilia A / complications*
  • Hemophilia A / drug therapy
  • Humans
  • Immunocompromised Host
  • Male
  • Muscular Diseases / complications*
  • Muscular Diseases / therapy
  • Nocardia Infections / complications*
  • Nocardia Infections / therapy
  • Opportunistic Infections / complications*
  • Opportunistic Infections / therapy
  • Prednisolone / adverse effects
  • Prednisolone / therapeutic use
  • Salvage Therapy
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Cyclosporine
  • Prednisolone